Long-term visual outcome of congenital cataract at a Tertiary Referral Center from 2004 to 2014

Abstract

Purpose: To assess the long-term visual acuity (VA) outcome after congenital cataract surgery at Imam Hossein Medical Center (Tertiary Referral Center) (2004-2014).

Methods: In this descriptive study, records of 120 patients with a history of congenital cataract surgery were studied. Those with traumatic, metabolic cataract, aged <5 years at the last visit who were not able to respond VA testing accurately and follow-up < 6 months were excluded. Cases with incomplete files were recalled and reexamined. Finally, the records of 42 patients (71 eyes) were included.

Results: In this study, 20 males and 22 females with a mean age of 11.80 ± 6 years at their last visit were studied. Bilateral and unilateral cataract was seen in 69% and 31% of cases, respectively. Posterior and anterior subcapsular opacity was the most common (53.70%) and rarest (1.90%) type of congenital cataract, respectively. The mean age at the time of operation and surgical interval was 65 ± 66.6 (range: 1-200) and 12.9 ± 23.5 (range: 0-96) months, respectively. The most common method of refractive error correction was pseudophakia plus glasses (56.3%) with the mean best corrected visual acuity (BCVA) of 0.29 ± 0.28 LogMAR., The mean BCVA was 0.7 ± 0.53 LogMAR for aphakic patients correcting by glasses. In our study, amblyopia (56%), glaucoma (23.90%), and posterior capsular opacity (16.40%) were observed during their follow-ups on an average of 76 ± 65 months (median: 60, range: 6-240). Unilateral cataract, aphakia, nystagmus, female gender, and strabismus were risk factors of VA loss.

Conclusion: Based on our results, 56% of cases showed amblyopia. It could be due to late operation (especially in unilateral cases), longer surgical interval between two eyes, and no compliance of amblyopia therapy. Early detection through screening may reduce the rate of amblyopia. Refractive errors, visual acuity, amblyopia, glaucoma, posterior capsular opacity, and compliance of amblyopia therapy should be checked regularly at follow-up visits.

Keywords: Best corrected visual acuity (BCVA); Complications; Congenital cataract surgery.

Fig. 1

Flowchart of our study procedure. MR: mental retardation; yrs: years; n: number.

Fig. 2

Different types of cataract. Mixed cataract: two or more types of cataract.

Fig. 3

Post-operative complications of our participants. PCO: Posterior Capsular Opacity; Vit: vitreous; IOL: Intra Ocular Lens.